内窥镜钬激光肾结石手术

Holmium laser ureteroscopy is a minimally invasive endoscopic procedure where a thin flexible or semi-rigid scope is passed through the urethra and ureter to reach the stone. A Ho:YAG laser fiber is then used to fragment the stone into small pieces or dust, which can pass naturally or be extracted. It is the gold standard for treating ureteral and kidney stones with a reported success rate of 95–96%.

The Ho:YAG laser is highly absorbed by water, which limits thermal spread and protects surrounding urinary tract tissue from heat damage. It cannot penetrate more than 5 cm in air, making it safe for surgeons. Modern Ho:YAG systems incorporate anti-retropulsion technology and high-frequency pulse modes that fragment stones more efficiently and reduce the chance of stones being pushed back into the kidney during the procedure.

The procedure is performed under general or spinal anesthesia, so there is no pain during the operation. Post-operatively, patients may experience mild urinary discomfort, frequency, or occasionally blood in urine, which typically resolves within a few days. A temporary ureteral stent is often placed after the procedure to ensure drainage and is removed in a follow-up visit. Most patients are discharged the same day or the following day.

Holmium laser ureteroscopy can treat stones of virtually any size, though the optimal indication is stones between 5 mm and 20 mm in the ureter or kidney. For larger stones (over 20 mm), percutaneous nephrolithotomy (PCNL) is generally preferred for first-line treatment. For very small stones under 4–5 mm, spontaneous passage is usually expected without surgical intervention.

Recovery is typically rapid. Most patients resume normal daily activities within 1–3 days and return to full activities within 1–2 weeks. A ureteral stent, if placed, is removed in an outpatient procedure after 1–2 weeks. Post-operative follow-up imaging is scheduled to confirm stone clearance and monitor for any residual fragments.